Enhancing the Benefits Management Model for Complex eHealth Efforts

This thesis suggests five ways to improve BM in complex eHealth efforts. First, the concept of BR was defined to clarify the existing conflation of the BR and BM concepts. Second, an extended and enhanced BMM was developed that incorporated the BM context, levels of complexity for both organizational and interorganizational initiatives, and the critical aspects of learning and governance. Third, three propositions concerning learning and governance in BM were suggested based on the new model, which can be used to inform future BM studies and guide empirical work. Fourth, the propositions were further translated into a six-question checklist to stimulate learning from the BM process itself. Finally, I provide suggestions for BM governance in interorganizational ICT efforts aiming to realize societal benefits.publishedVersio

Advancing Ehealth Education for the Clinical Health Professions

This is the final report of a project that aimed to encourage and support program coordinators and directors of Australian undergraduate and postgraduate coursework programs in all allied health, nursing and medical professions to address the need for Ehealth education for entry-level clinical health professionals

The Extent and Coverage of Current Knowledge of Connected Health: Systematic Mapping Study

Background: This paper examines the development of the Connected Health research landscape with a view on providing a historical perspective on existing Connected Health research. Connected Health has become a rapidly growing research field as our healthcare system is facing pressured to become more proactive and patient centred. Objective: We aimed to identify the extent and coverage of the current body of knowledge in Connected Health. With this, we want to identify which topics have drawn the attention of Connected health researchers, and if there are gaps or interdisciplinary opportunities for further research. Methods: We used a systematic mapping study that combines scientific contributions from research on medicine, business, computer science and engineering. We analyse the papers with seven classification criteria, publication source, publication year, research types, empirical types, contribution types research topic and the condition studied in the paper. Results: Altogether, our search resulted in 208 papers which were analysed by a multidisciplinary group of researchers. Our results indicate a slow start for Connected Health research but a more recent steady upswing since 2013. The majority of papers proposed healthcare solutions (37%) or evaluated Connected Health approaches (23%). Case studies (28%) and experiments (26%) were the most popular forms of scientific validation employed. Diabetes, cancer, multiple sclerosis, and heart conditions are among the most prevalent conditions studied. Conclusions: We conclude that Connected Health research seems to be an established field of research, which has been growing strongly during the last five years. There seems to be more focus on technology driven research with a strong contribution from medicine, but business aspects of Connected health are not as much studied

Improving quality of summative eHealth evaluations

Summative evaluation, which is conducted at the end of an eHealth trial or implementation,assesses outcomes, produces evidence, and advances knowledge of eHealth implementationsin healthcare provisions. Therefore, its high quality is essential in order to reap the benefits ofthe results generated by evaluation studies. Quality is achieved in eHealth evaluation throughcontextual sensitivity, adequate research design, adherence to standards, a mixed-methodresearch approach, and ethical handling of data. However, insufficient quality in eHealthevaluation studies leads to decision makers and other potential users disregarding their results,which leads to the resources and effort involved in conducting an evaluation being wasted.The purpose of this thesis is to study how summative eHealth evaluations can be improved tosupport the determination of eHealth value in a specific context as well as the use of evidenceproduced during eHealth interventions. This thesis is built on a single case study of a summativeeHealth evaluation of an eHealth implementation project within different healthcare contexts.The thesis focuses on the different phases of evaluation process, assesses adequacy of standards,explores value that the eHealth intervention delivered in different contexts, and studies howevidence from evaluation is further used.The thesis extends knowledge on eHealth evaluation quality by providing deeper insights intothe problems in the existing quality criteria and by introducing two new criteria for quality ineHealth evaluations: capturing value of an eHealth solution and involving healthcareprofessionals in the intervention and its evaluation. The thesis reveals that meeting some of thecriteria is not always practical, and that evaluators might make trade-offs among the criteria.The findings point to a need to improve methodologies for eHealth evaluations by providingbetter guidance to evaluators and validating evaluation standards in different locations. Thethesis also suggests viewing value of an eHealth solution as a holistic view of the createdmonetary and nonmonetary benefits of eHealth that require monetary and nonmonetarysacrifices in a particular context. In addition, the thesis proposes a model for assessing value ofan eHealth solution

Effects of critical success factors on maturity level of Hospital information systems

Hospitals are regarded as the most important part of a healthcare system. Generally, hospitals use Hospital Information System (HIS) as an infrastructure for recording, retrieval, and transmission of data, facilitation of decision-making processes, and other healthcare-related functions. An issue in HIS is that the implementation of the system in hospitals has always been associated with a high risk of failure. This study, therefore, aims to first assess the maturity of HIS in Iranian hospitals and then, examine the related Critical Success Factors (CSF) in order to mitigate the implementation risks of HISs to the authorities. Eleven hospitals under the administration of Medical University of Isfahan, Iran, were selected. Data was collected through a checklist designed based on Electronic Medical Record Adoption Model (EMRAM) expectations. Questionnaires were distributed to employees of the eleven identified hospitals using stratified sampling method in which 126 completed questionnaires were returned. The results revealed that all of the hospitals have reached to elementary stages of (EMRAM). In addition, 26 CSFs were found to be effective in HIS implementation success in the hospitals but some factors were found to be higher in the level of effectiveness. The findings were then evaluated by 14 experts who are familiar with the selected hospitals, the HIS concept and project implementation. The final results which included a comprehensive picture about the initial maturity status of HIS and also 12 more effective CSFs for successful implementation of HIS in the hospitals can provide guidance for hospital top managers and healthcare policy makers in developing appropriate strategic IT plans and HIS implementation frameworks

Polycentric Governance of Interorganizational Systems: Managerial and Architectural Arrangements

In an increasingly digital world, introducing new interorganizational systems requires establishing associations and relying on contributions of multiple actors that control existing technical solutions. This article examines the question: “how can large-scale system implementations across multiple organizations be governed in situations of distributed control over components?”. To answer this question, we present the findings of a longitudinal case study on the introduction of e-prescription in Norway over a 14-year period. The findings point to complementary architectural and managerial arrangements that make possible a polycentric governance approach. This work contributes to research on Information Systems Governance by providing insights relevant to mandating large-scale system implementations across organizations by mobilizing and orienting multiple contributors that control various pre-existing solutions

An exploration of ehealth and digital literacy in pharmacy practice.

The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatricks four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge

A mixed methods study of factors influencing health managers acceptance of eHealth services in the Kingdom of Saudi Arabia.

The Kingdom of Saudi Arabia (KSA) is a country with one of the largest land masses and most difficult geographical terrain in the Middle East. The accessibility of advanced health services, especially for people in rural areas, has been considered one of the main health challenges. Health services across the country are accessible through three categories of providers. The Ministry of Health (MOH), which is the dominant health provider, is responsible for 60% of all health services and facilities. The private health sector and other government-run health authorities are the providers for the remaining 40%. Many initiatives to embrace technology in healthcare were launched by the MOH to advance the level of acceptance. One of the initiatives was the ambitious National eHealth Strategy, which was launched in 2011 to govern eHealth projects across the country, and to set consistent standards, policies, and procedures for the practice activities. This study was sponsored by the MOH as part of a bigger plan to involve stakeholders in the digital transformation. The overall aim of this doctoral research was to explore the factors that influence health managers' acceptance of eHealth services in KSA. The 1st phase was a systematic review (SR): based on a PRISMA-P guided protocol published with CRD Prospero, five databases were searched for studies published between 1993 and 2017. One reviewer performed the search; two reviewers screened the titles and abstracts. Exclusions were recorded with reasons. Tools appropriate to study design were applied independently by two reviewers to assess the quality of included studies. After duplicates were removed, 110 papers were screened and 15 studies met the inclusion criteria. From these 15 papers, 39 factors were identified as influencing varying levels of eHealth adoption and acceptance in KSA. Lack of studies on the views of health managers and limited studies from only a few geographical settings were also identified as knowledge gaps. The 2nd phase was a survey: an online questionnaire in both Arabic and English language was designed around the Unified Theory of Acceptance and Use of Technology (UTAUT) model determinants. Professionals with a health managerial role from multiple disciplines - such as health professions, administration, and health IT - were invited to take part in the study. Ethical approval had been gained. Participation links were distributed across a range of social media platforms. SPSS v25 was used for data analysis. Findings from the 2nd phase survey showed the significance (p < 0.05) of Performance Expectancy and Social Influence moderated by age to the Behavioural Intention of health managers as well as the Performance Expectancy and Facilitating Conditions to the actual Use Behaviour. Some ambiguous results need further investigations. The 3rd phase consisted of a mixture of face-to-face and telephone in-depth interviews with 21 health managers from Aseer province, KSA. Four umbrella domains were derived from the UTAUT model. The pre-defined themes from phases 1 and 2 were explored and mapped against the domains. Ethical approval had been gained. Microsoft Excel and NVivo were used for the data analysis. Through the interviews, ambiguity in the previous phase was clarified and the most influential factors based on the views of health managers in Aseer province, KSA, were identified. Three domains out of four showed significance: Performance Expectancy, Social Influence, and Facilitating Conditions. This mixed methods research design presented across three phases was adopted with the findings from each phase informing the next. Overall, the research confirmed the influence of the same factors on health managers' acceptance of eHealth services in KSA and generated original findings. First, by providing evidence that this area has not been previously studied through registering a protocol and publishing a systematic review. Second, by using social media platforms to support a novel recruitment approach for the study. Third, by employing UTAUT as a theoretical framework in both quantitative and qualitative phases. Finally, exploring eHealth practice in Aseer province, a part of KSA that has not previously been explored in the published literature. These original findings draw a clearer picture of the potential challenges faced by health managers in KSA in accepting and using eHealth services. The findings may also work as a foundational basis from which to better prepare other stakeholder groups for accepting eHealth services. By doing so, staff can more effectively utilise health technology interventions as key concepts in making successful and positive transformational and sustainable change to the delivery of healthcare

Business Case and Technology Analysis for 5G Low Latency Applications

A large number of new consumer and industrial applications are likely to change the classic operator's business models and provide a wide range of new markets to enter. This article analyses the most relevant 5G use cases that require ultra-low latency, from both technical and business perspectives. Low latency services pose challenging requirements to the network, and to fulfill them operators need to invest in costly changes in their network. In this sense, it is not clear whether such investments are going to be amortized with these new business models. In light of this, specific applications and requirements are described and the potential market benefits for operators are analysed. Conclusions show that operators have clear opportunities to add value and position themselves strongly with the increasing number of services to be provided by 5G.Comment: 18 pages, 5 figure

Evidence based evaluation of eHealth interventions: A systematic literature review

Background: Until now, the use of technology in health care was driven mostly by the assumptions about the benefits of electronic health (eHealth) rather than its evidence. It is noticeable that the magnitude of evidence of effectiveness and efficiency of eHealth is not proportionate to the number of interventions that are regularly conducted. Reliable evidence generated through comprehensive evaluation of eHealth interventions may accelerate the growth of eHealth for long-term successful implementation and help to experience eHealth benefits in an enhanced way.Objective: This study aimed to understand how the evidence of effectiveness and efficiency of eHealth can be generated through evaluation. Hence, we aim to discern (1) how evaluation is conducted in distinct eHealth intervention phases, (2) the aspects of effectiveness and efficiency that are typically evaluated during eHealth interventions, and (3) how eHealth interventions are evaluated in practice.Methods: A systematic literature review was conducted to explore the evaluation methods for eHealth interventions. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. We searched Google Scholar and Scopus for the published papers that addressed the evaluation of eHealth or described an eHealth intervention study. A qualitative analysis of the selected papers was conducted in several steps.Results: We intended to see how the process of evaluation unfolds in distinct phases of an eHealth intervention. We revealed that in practice and in several conceptual papers, evaluation is performed at the end of the intervention. There are some studies that discuss the importance of conducting evaluation throughout the intervention; however, in practice, we found no case study that followed this. For our second research question, we discovered aspects of efficiency and effectiveness that are proposed to be assessed during interventions. The aspects that were recurrent in the conceptual papers include clinical, human and social, organizational, technological, cost, ethical and legal, and transferability. However, the case studies reviewed only evaluate the clinical and human and social aspects. At the end of the paper, we discussed a novel approach to look into the evaluation. Our intention was to stir up a discussion around this approach with the hope that it might be able to gather evidence in a comprehensive and credible way.Conclusions: The importance of evidence in eHealth has not been discussed as rigorously as have the diverse evaluation approaches and evaluation frameworks. Further research directed toward evidence-based evaluation can not only improve the quality of intervention studies but also facilitate successful long-term implementation of eHealth in general. We conclude that the development of more robust and comprehensive evaluation of eHealth studies or an improved validation of evaluation methods could ease the transferability of results among similar studies. Thus, the resources can be used for supplementary research in eHealth